Jang Se Youn, Kim Choong Hyun, Cheong Jin Hwan, Kim Jae Min
Department of Neurosurgery, Seoul Medical Center, Seoul, Korea.
Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Korean J Neurotrauma. 2018 Oct;14(2):112-117. doi: 10.13004/kjnt.2018.14.2.112. Epub 2018 Oct 31.
Placement of a ventriculoperitoneal (VP) shunt is a common neurosurgical procedure for cerebrospinal fluid diversion. A rare complication is delayed intracranial hemorrhage (ICH) secondary to VP shunting, and only a few patients with this complication have been reported. We investigate the incidence and risk factors of delayed ICH development following VP shunt placement.
Over an 11-year period, 167 patients received a VP shunt for hydrocephalus, and of these, 138 patients were eligible for this study. All medical records and computed tomography scans obtained within 48 h after the operation and at postoperative day 7 were reviewed. The risk factors of developing delayed ICH (≥48 hr after VP shunt placement) were analyzed according to the demographic data, including sex and age, original intracranial lesions, co-morbid diseases, and laboratory findings.
Delayed ICH following VP shunt placement developed in 34 (24.6%) of the 138 patients. Risk factors for developing delayed ICH were age (=0.037) and the partial thromboplastin time (PTT) (=0.032). Intraventricular hemorrhage after VP shunting was the most common complication, occurring in 16 cases. Hemorrhagic volume was <1 mL in 28 cases and >1 mL in 6 cases.
This study suggests that old age and delayed PTT are major risk factors for developing delayed ICH following VP shunting. Additionally, delayed ICH after VP shunting commonly occurs even when most patients are asymptomatic. Therefore, extra care should be taken to observe and follow-up with patients who have undergone VP shunt placement.
脑室腹腔（VP）分流术是一种常见的用于脑脊液引流的神经外科手术。一种罕见的并发症是VP分流术后迟发性颅内出血（ICH），仅有少数患有此并发症的患者被报道。我们调查了VP分流术后迟发性ICH发生的发生率及危险因素。
在11年期间，167例患者因脑积水接受了VP分流术，其中138例患者符合本研究条件。回顾了所有在术后48小时内及术后第7天获得的病历和计算机断层扫描。根据人口统计学数据，包括性别和年龄、原颅内病变、合并疾病及实验室检查结果，分析发生迟发性ICH（VP分流术后≥48小时）的危险因素。
138例患者中有34例（24.6%）发生了VP分流术后迟发性ICH。发生迟发性ICH的危险因素为年龄（=0.037）和部分凝血活酶时间（PTT）（=0.032）。VP分流术后脑室内出血是最常见的并发症，发生16例。出血量<1 mL的有28例，>1 mL的有6例。
本研究表明，高龄和PTT延长是VP分流术后发生迟发性ICH的主要危险因素。此外，即使大多数患者无症状，VP分流术后迟发性ICH也常发生。因此，对于接受VP分流术的患者应格外注意观察和随访。
